Dr. Amy Nett: I think the question and what you need to put into context is you have a patient with poorly controlled blood sugar and you have to put that patient onto, they’ve tried all of the different dietary approaches, we’re not seeing movement in blood sugar, we need to lower it with some assistance. You have somewhat of a limited number of options. You can do metformin and there are certainly some reasons to consider metformin, some patients are just going to be against the idea of taking a prescription and that’s okay. So then we have to think about the herbs. We’ve talked about these, some come in combination, there’s GlucoSupreme, there’s a new product called I think Gluco-Mend from Douglas Labs that’s fairly similar, but a combination of things like berberine and gymnema, fenugreek, cinnamon, chromium, things that help stabilize blood sugar.
We talked about berberine particularly because there had been a study, at least one study that showed berberine may actually be as effective as metformin. So the question is always risk-benefit and I think we talked about, it was either last week or the week before, is it really appropriate to use berberine long-term? And again it’s risk-benefit, I’m not sure that it does make sense to use berberine long term unless blood sugars remain poorly controlled, in which case the risks probably might be met by the benefits.
So look at the patient’s gut studies. Did they have an adequate number of beneficial bugs on the Doctor’s Data stool test? Is it somebody who has low levels of beneficial bacteria? So I think in some cases, yes, berberine probably is effective and appropriate despite the rest of the G.I. microbiome. But you’re right, it’s something that you need to consider and really look at the whole context, not just blood sugar alone.